Endoscopic surgery device

ABSTRACT

An insertion part of an endoscope and an insertion part of a treatment tool, which are inserted in an outer tube, can be synchronously moved in the axial direction, and, even when the insertion part of the treatment tool is slightly moved in the axial direction, an excellent endoscopic image without shake is obtained. When a treatment tool of an endoscopic surgery device moves by a displacement amount over an allowance amount, an endoscope moves in interlock with the movement of the treatment tool. Moreover, the treatment tool 50 moves in the axial direction with the allowance amount t with respect to the endoscope 10. Therefore, when the treatment tool is moved by a displacement amount of allowance amount or less, the endoscope does not move. By providing such allowance amount, slight movement of the treatment tool is not transmitted to the endoscope.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional application of U.S. application Ser.No. 14/868,398, filed on Sep. 29, 2015, now allowed. This priorapplication Ser. No. 14/868,398 is a Continuation of PCT InternationalApplication No. PCT/JP2014/058778 filed on Mar. 27, 2014, which claimspriority under 35 U.S.C. § 119(a) to Japanese Patent Application No.2013-074014 filed on Mar. 29, 2013. Each of the above application(s) ishereby expressly incorporated by reference, in its entirety, into thepresent application.

BACKGROUND OF THE INVENTION Field of the Invention

The present invention relates to an endoscopic surgery device, andparticularly relates to an endoscopic surgery device that can operate anendoscope and a treatment tool which are inserted in a body cavity ininterlock with each other.

Description of the Related Art

Recently, endoscopic surgery using an endoscope (rigid endoscope) suchas a laparoscope is widely performed because invasion to a patient issmall as compared with surgery in which laparotomy and thoracotomy, andso on, are performed. For example, in laparoscopic surgery, a trocar isinserted in multiple places of patient's abdomen, an endoscope, atreatment tool or the like is inserted in a body cavity using aninsertion hole formed in the trocar as a guide, and various kinds oftreatments are performed using the treatment tool while observing anobservation image (endoscope image) by a monitor.

In general, a surgeon's hands are busy by the operation of treatmenttools in endoscopic surgery. Therefore, the operation of an endoscope isperformed by an assistant who is called a scopist. However, in a casewhere the assistant operates the endoscope, the surgeon has tosequentially give an instruction to the assistant, and there areproblems that a work to correctly turn the direction of the endoscope toa direction desired by the surgeon is difficult and the surgeon suffersstress. Moreover, since the assistance performs an operation after thesurgeon gives an instruction, there is a problem of taking time toperform a surgery. In addition, the assistant has to operate theendoscope so as not to obstruct the surgeon's surgery, and there is aproblem that the operation is likely to become complicated.

Meanwhile, Japanese Patent Application Laid-Open No. 2007-301378 (PTL 1)discloses a technique that inserts a treatment tool and an endoscopefrom opening portions formed in different positions in a body wall intobody cavities respectively in endoscopic surgery and synchronously movesthe endoscope according to the movement of the treatment tool. Accordingto this technique, since the endoscope synchronously moves according tothe surgeon's operation of the treatment tool, the assistant's operationof the endoscope becomes unnecessary, the surgeon's stress with theassistant is eliminated, the surgeon can perform a surgery as desired,and therefore it is convenient. Moreover, in the technique disclosed inPTL 1, to prevent an observation image obtained by the endoscope fromslightly moving and being difficult to be seen, it is determined whetherthe distal end of the treatment tool is in the inner region of theobservation image or it is in a peripheral region, the visual field ofthe endoscope is not changed in a case where the distal end of thetreatment tool exists in the inner region of the observation image, andthe visual field of the endoscope is changed such that the distal end ofthe treatment tool comes to the center of the observation image in acase where the distal end of the treatment tool exists in the outerregion. By this means, it becomes possible to prevent the image frombeing rather difficult to be seen due to the slight movement of theobservation image in interlock with the slight movement of the treatmenttool.

Moreover, Japanese Patent Application Laid-Open No. 2004-180858 (PTL 2)and Japanese Patent Application Laid-Open No. 2004-141486 (PTL 3)disclose a technique in which: two insertion holes are provided in anouter tube which penetrates through a body wall and is inserted in abody cavity; and the endoscope is inserted in one insertion hole and thetreatment tool is inserted in the other insertion hole. According tothis technique, low invasion is achieved because it is possible toreduce the number of opening portions formed in a body wall to insertthe treatment tool and the endoscope in the body cavity.

SUMMARY OF THE INVENTION

However, in the technique disclosed in PTL 1, it is effective in a casewhere the distal end of the treatment tool moves in a directionorthogonal to the visual field direction of the endoscope, but, if azoom device is moved in interlock with a back-and-forth movement in theaxial direction of the treatment tool, the size of an observation targetchanges in interlock with the slight movement of the treatment tool, andthere is a problem that a depth perception is difficult to berecognized.

Moreover, in PTLs 2 and 3, there is no technical idea of synchronouslymoving the endoscope and the treatment tool which are inserted in thesame outer tube, and there is no description that suggests a problemcaused when the endoscope and the treatment tool are moved in interlockwith each other.

The present invention is made in view of such circumstances, and aims toprovide an endoscopic surgery device with high operability that caneasily obtain an image desired by a surgeon.

To achieve the above-mentioned object, an aspect of the presentinvention provides an endoscopic surgery device including: an endoscopeincluding observation means (observation unit) in a distal end of arod-shaped insertion part; a treatment tool including an operation unitin a proximal end of a rod-shaped insertion part; and an outer tubeincluding an endoscope insertion path in which the insertion part of theendoscope is insertable in a back-and-forth movable manner, and atreatment tool insertion path in which the insertion part of thetreatment tool is insertable in a back-and-forth movable manner, whereinthe insertion part of the endoscope inserted in the endoscope insertionpath is configured to be movable back and forth with a predeterminedallowance amount, in interlock with the back-and-forth movement of theinsertion part of the treatment tool inserted in the treatment toolinsertion path.

According to the aspect of the present invention, in the endoscopicsurgery device including the endoscope, the treatment tool and the outertube, at the time when the insertion part of the treatment tool isoperated in the back-and-forth direction, if the operation is made overthe allowance amount, the insertion part of the endoscope moves in theback-and-forth direction in interlock with the movement in theback-and-forth direction of the insertion part of the treatment tool.Therefore, the insertion part of the endoscope and the insertion part ofthe treatment tool, which are inserted in the outer tube, move in theback-and-forth direction in an interlocked manner (in a synchronousmanner). Moreover, the insertion part of the treatment tool moves in theaxial direction of the outer tube with the predetermined allowanceamount with respect to the insertion part of the endoscope. By thismeans, when the insertion part of the treatment tool is moved in theback-and-forth direction, if the movement is within a range of theallowance amount, the endoscope does not move in the back-and-forthdirection. By providing the allowance amount, since the slight movementof the treatment tool is not transmitted to the endoscope by providing,it is possible to obtain an excellent endoscopic image without shake.

Therefore, it is possible to prevent the size of the observation targetfrom varying in a case where the insertion part of the treatment tool isslightly displaced in the back-and-forth direction (in a case where aback-and-forth operation of small amplitude is performed), appropriatelykeep a depth perception and provide a stable observation image.Moreover, in a case where the insertion part of the treatment tool islargely displaced in the back-and-forth direction (in a case where aback-and-forth operation of large amplitude is performed), since therange of the observation image is continuously changed in interlock withthe displacement of the insertion part of the treatment tool, the sizeof the observation target changes according to the operation of thetreatment tool, an image desired by a surgeon can be easily obtained,and the operability improves.

In an aspect of the present invention, it is preferable that aback-and-forth movement amount of the insertion part of the treatmenttool with respect to the outer tube is 60 mm or more, and the allowanceamount in an axial direction of the insertion part of the treatment toolwith respect to the insertion part of the endoscope is 10 mm to 30 mm.

According to the aspect of the present invention, in the back-and-forthmovement amount of the insertion part of the treatment tool with respectto the outer tube, since a movement amount of 60 mm or more togetherwith the allowance amount of 10 mm to 30 mm, is within a substantial userange which is normally used by a surgeon, the surgeon can operate thetreatment tool without a sense of incompatibility.

Here, it is preferable that the back-and-forth movement amount of theinsertion part of the treatment tool with respect to the outer tube is80 mm or less, and it is more preferable that it is 70 mm.

Moreover, it is more preferable that the allowance amount is from 15 mmto 25 mm, and it is further preferable that it is 20 mm.

In an aspect of the present invention, it is preferable that theendoscopic surgery device includes a coupling member which is disposedinside the outer tube and configured to couple the insertion part of theendoscope and the insertion part of the treatment tool, wherein thecoupling member includes: a first movable object which includes anendoscope holding member that holds the insertion part of the endoscopeand is configured to move back and forth in an integral manner with theinsertion part of the endoscope; and a second movable object whichincludes a treatment tool holding member that holds the insertion partof the treatment tool and is configured to move back and forth in anintegral manner with the insertion part of the treatment tool, and oneof the first movable object and the second movable object is configuredto move back and forth with the allowance amount in interlock with theback-and-forth movement of another one of the first movable object andthe second movable object.

According to the aspect of the present invention, by providing thecoupling member including the first movable object and the secondmovable object in the outer tube, it is possible to move the insertionpart of the endoscope and the insertion part of the treatment tool,which are inserted in the outer tube, in the back-and-forth direction ininterlocked manner. In addition, even in a case where the insertion partof the treatment tool is slightly moved in the back-and-forth direction,it is possible to obtain an excellent endoscopic image without shake. Inan aspect of the present invention, it is preferable that: the firstmovable object is held to the outer tube through a first friction force(F1); and the second movable object holds the insertion part of thetreatment tool through a second friction force (F2) larger than thefirst friction force (F1), is held to the first movable object through athird friction force (F3) less than the first friction force (F1) and isslid by the allowance amount with respect to the first movable object.

According to a mode of the present invention, by setting therelationship of friction force to F2>F1>F3, the endoscope smoothly movesin the back-and-forth direction in interlock with the movement in theback-and-forth direction of the treatment tool, and the treatment toolsmoothly slides by the allowance amount in the back-and-forth directionof the outer tube with respect to the endoscope.

According to the present invention, the range of an observation imageobtained by an endoscope is changed with an allowance with respect tothe forward/backward movement of a treatment tool. By this means, it ispossible to prevent the size of the observation target from varying in acase where an insertion part of the treatment tool is slightly displacedin the axial direction (in a case where a back-and-forth operation ofsmall amplitude is performed), appropriately keep a depth perception andprovide a stable observation image. Moreover, in a case where thetreatment tool is largely displaced in the axial direction (in a casewhere a back-and-forth operation of large amplitude is performed), sincethe range of the observation image obtained by the endoscope is changedin interlock with the displacement of the treatment tool, the size ofthe observation target changes according to the operation of thetreatment tool, an image desired by a surgeon can be easily obtained,and the operability improves.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic configuration diagram of an endoscopic surgerydevice of an embodiment.

FIG. 2 is a schematic configuration diagram illustrating one example ofan endoscope.

FIG. 3 is a schematic configuration diagram illustrating one example ofneedle light.

FIG. 4 is a schematic configuration diagram illustrating one example ofa treatment tool.

FIG. 5 is a perspective view illustrating one example of an outer tube.

FIG. 6 is a front view of a distal end surface of an outer tube in whichan endoscope and a treatment tool are inserted.

FIG. 7 is a side part cross-sectional view of an outer tube in which anendoscope and a treatment tool are inserted.

FIG. 8 is a front view of a proximal end surface of an outer tube.

FIG. 9 is an explanatory diagram illustrating a mode when an endoscopicsurgery device is used.

FIG. 10 is a schematic explanatory diagram illustrating one example of asurgery procedure using an endoscopic surgery device.

FIG. 11 is a cross-sectional view of an outer tube to describe theforward/backward movement amount of an insertion part of a treatmenttool with respect to the outer tube.

FIG. 12 is a partial cross-sectional view in which an insertion part ofan endoscope is inserted in an outer tube.

FIG. 13 is a cross-sectional view of an outer tube to describe theforward/backward movement amount of an insertion part of a treatmenttool with respect to an outer tube.

FIG. 14 is a schematic diagram illustrating an internal structure of anouter tube of an endoscopic surgery device according to the secondembodiment.

FIG. 15 is a configuration diagram illustrating structures of a sliderand sleeve of the outer tube in FIG. 14 .

FIG. 16 is a flowchart diagram illustrating one example of processingperformed by a control unit.

FIG. 17 is a diagram illustrating a state where an insertion part ispressed from the hand side to the patient side in a body cavity.

FIG. 18 is a schematic configuration diagram illustrating a mainconfiguration of an endoscope device according to the third embodiment.

FIG. 19 is a functional block diagram illustrating a main configurationof an endoscopic surgery device according to the fourth embodiment.

FIG. 20 is a diagram to describe the difference between a movementamount on an endoscope image and an actual movement amount.

FIG. 21 is a diagram to describe conversion processing performed in asecond conversion processing unit.

FIG. 22 is a schematic diagram illustrating an internal structure of anouter tube according to the fifth embodiment.

FIG. 23 is a graph illustrating the relationship between a movementamount of an insertion part and a movement amount of an insertion part.

FIG. 24 is a flowchart diagram illustrating one example of processingperformed in a control unit.

FIG. 25 is a schematic diagram illustrating an internal structure of anouter tube according to the sixth embodiment.

FIG. 26 is a configuration diagram illustrating structures of a sliderand a sleeve.

FIG. 27 is a diagram illustrating a state where an insertion part ispushed from the hand side to the patient side in a body cavity.

DETAILED DESCRIPTION OF THE EMBODIMENTS

In the following, preferable embodiments of the endoscopic surgerydevice according to the present invention are described in detailaccording to the accompanying drawings.

FIG. 1 is a schematic configuration diagram of an endoscopic surgerydevice 1 according to the first embodiment.

First Embodiment

The endoscopic surgery device 1 includes an endoscope 10 that isinserted into a patient's body cavity and observes the inside of thebody cavity, a treatment tool 50 that is inserted into the patient'sbody cavity and performs necessary treatment, and an outer tube 100 thatguides the endoscope 10 and the treatment tool 50 into the patient'sbody cavity. In FIG. 1 , Ls designates the length of a straightrod-shaped insertion part 12 of the endoscope 10, Lh designates thelength of a straight rod-shaped insertion part 52 of the treatment tool50, and Lt designates the length of the outer tube 100. In theendoscopic surgery device 1 of FIG. 1 , the relationship among Ls, Lhand Lt is Lt<Ls<Lh, but it may have a relationship of Lt<Ls<Lh.Moreover, “a” in FIG. 1 designates the forward/backward movement amountof the insertion part 52 of the treatment tool 50 with respect to theouter tube 100. Forward/backward movement amount “a” is set to 60 mm ormore in the embodiment.

Endoscope 10

FIG. 2 is a schematic configuration diagram illustrating one example ofthe endoscope 10.

The endoscope 10 is a direct-view rigid endoscope such as a laparoscope.The endoscope 10 includes a straight rod-shaped insertion part 12inserted into a patient's body cavity and a flexible cable 22 connectedwith a proximal end of the insertion part 12.

Observation means including an object lens 16 and an imaging element(for example, a CCD (Charge Coupled Device) and a CMOS (ComplementaryMetal-Oxide Semiconductor), and so on) 20 that is imaging means is builtinto a distal end of the insertion part 12. An observation image fromthe object lens 16 is formed on an image formation surface of theimaging element 20, and an image signal generated in the imaging element20 is output to an image processing device 24 through the cable 22. Theimage processing device 24 performs various kinds of processing on theimage signal imported from the imaging element 20 and generates a videosignal that can be output to a display 26. The viewing angle of thisobservation means is 120 degrees, for example.

The display 26 such as a liquid crystal display is connected with theimage processing device 24. The video signal generated in the imageprocessing device 24 is output to the display 26 and displayed on thescreen of the display 26 as an endoscopic image.

Here, illumination means is not provided in the endoscope 10 in FIG. 2 .Illumination is performed by needle light that is another means. Theexternal diameter of the insertion part 12 of the endoscope 10 can bemade narrower by omitting the illumination means to be built in theendoscope. By this means, an external diameter of the outer tube 100also can be made narrower, it is possible to reduce invasion to thepatient's body wall.

Needle Light 30

FIG. 3 is a schematic configuration diagram illustrating one example ofthe needle light 30.

The needle light 30 is a member that is inserted into the patient's bodycavity and illuminates the inside of the body cavity.

The needle light 30 has a straight rod-shaped insertion part 32 thereof.An illumination window (not illustrated) is provided in a distal end ofthe insertion part 32, and illumination light is irradiated from thisillumination window to an axial direction. An optical fiber bundle thattransmits the illumination light irradiated from the illumination windowis housed inside the insertion part 32.

A connection part 34 is provided in a proximal end of the needle light30. A light source device 38 is connected with the connection part 34through a cable 36 having flexibility. The illumination light emittedfrom the illumination window is supplied from the light source device38. The needle light 30 is inserted in a body cavity through anarrow-diameter trocar 40 for needle light.

Treatment Tool 50

FIG. 4 is a schematic configuration diagram illustrating one example ofthe treatment tool 50.

The treatment tool 50 includes a straight rod-shaped insertion part 52which is inserted in a body cavity, a treatment part 54 arranged in adistal end of the insertion part 52 and a handle 56 arranged in aproximal end of the insertion part 52. The treatment part 54 illustratedin FIG. 5 is configured to have a scissors structure, and the treatmentpart 54 is subjected to opening and closing operation by the opening andclosing operation of the handle 56. Here, the treatment tool 50 is notlimited to this, and a forceps, a laser probe, a suture instrument, aradio knife, a needle holder and an ultrasonic aspirator, and so on, canbe used as a treatment tool.

Outer Tube 100

FIG. 5 is a perspective view illustrating one example of the outer tube100.

The outer tube 100 is tapped into the patient's body cavity wall andguides the insertion part 12 of the endoscope 10 and the insertion part52 of the treatment tool 50 into the patient's body cavity.

FIG. 6 is a front view of the distal end surface of the outer tube 100in which the endoscope 10 and the treatment tool 50 are inserted, FIG. 7is a side part cross-sectional view of the outer tube 100 in which theendoscope 10 and the treatment tool 50 are inserted, and FIG. 8 is afront view of a proximal end surface of the outer tube 100.

The outer tube 100 has a cylindrical outer tube body 102. A cap 104 isattached to the proximal end of the outer tube body 102. A valve memberthat secures the air tightness is housed in the cap 104, and a proximalend opening portion of the outer tube body 102 is blocked by this valvemember. A cap 106 is attached to a distal end of the outer tube body102, and a distal end opening portion of the outer tube body 102 isblocked by this cap 106.

As illustrated in FIGS. 5 and 8 , a treatment tool entry port 108 toinsert the insertion part 52 of the treatment tool 50 in the outer tubebody 102 is provided in the cap 104. The treatment tool entry port 108is formed to have an internal diameter corresponding to an externaldiameter of the insertion part 52 of the treatment tool 50.

Moreover, an endoscope entry port 112 to insert the insertion part 12 ofthe endoscope 10 in the outer tube body 102 is provided in the cap 104.The endoscope entry port 112 is formed to have an internal diametercorresponding to an external diameter of the insertion part 12 of theendoscope 10.

As illustrated in FIG. 6 , a treatment tool exit port 114 from which theinsertion part 52 of the treatment tool 50 inserted in the outer tubebody 102 is delivered is provided in the cap 106. The treatment toolexit port 114 is formed to have an internal diameter corresponding to anexternal diameter of the insertion part 52 of the treatment tool 50. Thetreatment tool entry port 108 in FIG. 8 and the treatment tool exit port114 in FIG. 6 are disposed on the same axis which is parallel to theaxis of the outer tube body 102. By this means, as illustrated in FIG. 7, the treatment part 54 of the treatment tool 50 inserted from thetreatment tool entry port 108 (see FIG. 8 ) is delivered from thetreatment tool exit port 114 (see FIG. 6 ). At this time, the insertionpart 52 of the treatment tool 50 is delivered with a posture parallel tothe axis of the outer tube body 102. Here, in the outer tube body 102, aconduit line that communicates the treatment tool entry port 108 and thetreatment tool exit port 114 forms a treatment tool insertion path inwhich the insertion part 52 of the treatment tool 50 moves back andforth in the axial direction of the insertion part 52.

Moreover, the cap 106 in FIG. 6 is provided with an endoscope exit port116 from which the insertion part 12 of the endoscope 10 inserted fromthe endoscope entry port 112 in FIG. 8 into the outer tube body 102 isdelivered. The endoscope exit port 116 is formed to have an internaldiameter corresponding to the external diameter of the insertion part 12of the endoscope 10. The endoscope entry port 112 (see FIG. 8 ) and theendoscope exit port 116 (see FIG. 6 ) are disposed on the same axis andwhich is parallel to the axis of the outer tube body 102. By this means,as illustrated in FIG. 7 , the distal end part of the endoscope 10inserted from the endoscope entry port 112 (see FIG. 8 ) is deliveredfrom the endoscope exit port 116 (see FIG. 6 ). At this time, theinsertion part 12 of the endoscope 10 is delivered with a postureparallel to the axis of the outer tube body 102. Here, in the outer tubebody 102, a conduit line that communicates the endoscope entry port 112and the endoscope exit port 116 forms an endoscope insertion path inwhich the insertion part 12 of the endoscope 10 moves back and forth inthe axial direction of the insertion part 12.

Internal Structure of Outer Tube 100

As illustrated in FIG. 7 , a slider (first movable object) 118 that ismovable in a direction parallel to the axis of the outer tube body 102is provided inside the outer tube body 102.

The slider 118 is formed in a columnar shape, which can be housed in theouter tube body 102. The slider 118 is provided so as to be guided by apair of guide shafts 120 and reciprocately move in the outer tube body102 along the axis of the outer tube body 102.

Each guide shaft 120 is a round rod-shaped and is disposed inside theouter tube body 102 (see FIG. 6 ). Moreover, proximal ends of the guideshafts 120 are supported by the cap 104, and distal ends of the guideshafts 120 are supported by the cap 106. The guide shafts 120 aredisposed in parallel to the axis of the outer tube body 102.

A pair of guide holes 122 in which the pair of guide shafts 120 can beinserted is included in the slider 118. The pair of guide holes 122 isformed in parallel to the axis of the outer tube body 102. The slider118 is movably supported by the guide shafts 120 through the guide holes122.

The slider 118 includes a treatment tool holding part 124 that holds theinsertion part 52 of the treatment tool 50 inserted in the outer tubebody 102, and an endoscope holding part 126 that holds the insertionpart 12 of the endoscope 10 inserted in the outer tube body 102. Theendoscope holding part 126 includes an endoscope holding hole 132 inwhich the insertion part 12 of the endoscope 10 is inserted, and a pairof O-rings 134 disposed in the endoscope holding hole 132.

The endoscope holding hole 132 is formed penetrating the slider 118. Theendoscope holding hole 132 is formed in parallel to the axis of theouter tube body 102 and disposed on the same axis as the endoscope entryport 112 and the endoscope exit port 116.

The pair of O-rings 134 is provided in two front and rear positionsinside the endoscope holding hole 132. The internal diameter of thisO-ring 134 is set to be slightly smaller than the external diameter ofthe insertion part 12 of the endoscope 10.

The insertion part 12 of the endoscope 10 inserted from the endoscopeentry port 112 into the outer tube body 102 is delivered from theendoscope exit port 116 through the endoscope holding hole 132. Theendoscope 10 passes through the O-rings 134 when passing through theendo scope holding hole 132. As mentioned above, the internal diameterof each O-ring 134 is set to be slightly smaller than the externaldiameter of the insertion part 12 of the endoscope 10. Therefore, whenpassing through the endoscope holding hole 132, the insertion part 12 ofthe endoscope 10 is held to the endoscope holding hole 132 by theelastic force of the O-rings 134.

Here, since the hold here denotes hold by the elastic force of theO-rings 134, the holding position of the insertion part 12 of theendoscope 10 with respect to the slider 118 can be arbitrarily adjusted.

Moreover, the endoscope 10 is held by the elastic force of the O-rings134, but the friction force between the O-rings 134 and the insertionpart 12 of the endoscope 10 is set to be larger than the friction forcebetween the guide shafts 120 and the guide holes 122 (=the frictionforce between the outer tube body 102 and the slider 118: F1). By thismeans, the slider 118 and the insertion part 12 the endoscope 10 movewith respect to the outer tube body 102 in an integral manner.

The treatment tool holding part 124 includes a treatment tool holdinghole 128 in which the insertion part 52 of the treatment tool 50 isinserted, a sleeve (second movable object) 140 that moves in the axialdirection along the treatment tool holding hole 128, and a pair ofO-rings 130 disposed in the sleeve 140. A coupling member includes theslider 118 and the sleeve 140.

The treatment tool holding hole 128 is formed penetrating the slider118. The treatment tool holding hole 128 is formed in parallel to theaxis of the outer tube body 102 and is disposed on the same axis as thetreatment tool entry port 108 and the treatment tool exit port 114.

A circular stopper ring 142 is attached to both end parts of thetreatment tool holding hole 128. The sleeve 140 housed in the treatmenttool holding hole 128 is prevented from coming out from the treatmenttool holding hole 128 by the stopper rings 142 and 142. Moreover, as forthe sleeve 140, the allowance amount tin the back-and-forth direction isset by the stopper rings 142 and 142. That is, the sleeve 140 is set soas to be slidable by the allowance amount t with respect to the slider118 between the stopper rings 142 and 142 provided in both ends of thetreatment tool holding hole 128.

The sleeve 140 is formed in a cylindrical shape, housed inside thetreatment tool holding hole 128 and disposed on the same axis as thetreatment tool holding hole 128. That is, the sleeve 140 is disposed onthe same axis as the treatment tool entry port 108 and the treatmenttool exit port 114. By this means, when the insertion part 52 of thetreatment tool 50 is inserted from the treatment tool entry port 108along the axial direction, the insertion part 52 is inserted in theinner peripheral part of the sleeve 140.

The pair of O-rings 130 is provided in two front and rear positionsinside the sleeve 140. The internal diameter of this O-ring 130 is setto be slightly smaller than the external diameter of the insertion part52 of the treatment tool 50.

The insertion part 52 inserted from the treatment tool entry port 108into the outer tube body 102 is delivered from the treatment tool exitport 114 through the treatment tool holding hole 128. When passingthrough the treatment tool holding hole 128, the insertion part 52passes through the O-rings 130 disposed in an inner peripheral part ofthe sleeve 140. The internal diameter of the O-rings 130 is set to beslightly smaller than an external diameter of the insertion part 52 ofthe treatment tool 50. Therefore, when passing through the O-rings 130,the insertion part 52 is held to the sleeve 140 by the elastic force ofthe O-rings 130.

Here, since the hold here denotes hold by the elastic force of theO-rings 130, the holding position of the treatment tool 50 with respectto the sleeve 140 can be arbitrarily adjusted. That is, the holdingposition of the insertion part 52 with respect to the slider 118 can bearbitrarily adjusted. Here, Ls1 in FIG. 7 designates the minimumprojection length of the distal end of the insertion part 52 of thetreatment tool 50 based on the distal end of the insertion part 12 ofthe endoscope 10.

In the treatment tool holding part 124, the sleeve 140 is integratedwith the insertion part 52 of the treatment tool 50, and the sleeve 140moves in interlock with the back-and-forth operation of the insertionpart 52.

Here, in a case where the friction force (F3) between the sleeve 140 andthe treatment tool holding hole 128 is larger than the friction force(F2) between the insertion part 52 of the treatment tool 50 and theO-rings 130, the insertion part 52 slides between the insertion part 52and the O-rings 130, and it is not possible to move the sleeve 140 withrespect to the slider 118. For such a reason, the friction force (F3)between the sleeve 140 and the treatment tool holding hole 128 is set tobe smaller than the friction force (F2) between the treatment tool 50and the O-rings 130.

On the other hand, if the friction force (F3) between the sleeve 140 andthe treatment tool holding hole 128 is larger than the friction forcebetween the guide shafts 120 and the guide holes 122 (=the frictionforce between the outer tube body 102 and the slider 118: F1), when thetreatment tool 50 is moved, the slider 118 moves with respect to theouter tube body 102 instead of the sleeve 140. For such a reason, thefriction force (F1) between the guide shafts 120 and the guide holes 122is set to be larger than the friction force (F3) between the sleeve 140and the treatment tool holding hole 128. Moreover, the friction force(F2) between the treatment tool 50 and the O-rings 130 is set to belarger than the friction force (F1) between the guide shafts 120 and theguide holes 122.

That is, the relationship among the friction force (F1) between theguide shafts 120 and the guide holes 122, the friction force (F2)between the treatment tool 50 and the O-rings 130 and the friction force(F3) between the sleeve 140 and the treatment tool holding hole 128 areset to be F2>F1>F3.

By this means, when the insertion part 52 of the treatment tool 50 ismoved in the back-and-forth direction, if the movement is not more thanan allowance amount t set by the pair of stopper rings 142 and 142, theslider 118 does not move and the endoscope 10 does not synchronouslymove in the back-and-forth direction.

By providing such allowance amount t, for example, in a case where theinsertion part 52 is slightly displaced in the back-and-forth direction(in a case where a back-and-forth operation of small amplitude isperformed), it is possible to prevent an endoscopic image displayed onthe display 26 from shaking. Therefore, it is possible to provide aneasily visible endoscopic image without shake.

Here, in the above-mentioned example, the insertion part (one insertionpart) 12 of the endoscope 10 is held to the slider 118 and the insertionpart (the other insertion part) 52 of the treatment tool 50 is held tothe sleeve 140. However, even if the insertion part 12 of the endoscope10 is held to the sleeve 140 and the insertion part 52 of the treatmenttool 50 is held to the slider 118, it is possible to obtain similaroperation and effect.

<<Operation of Endoscopic Surgery Device 1>>

FIG. 9 is a diagram illustrating a mode when the endoscopic surgerydevice 1 is used.

The insertion part 12 of the endoscope 10 inserted in the outer tube 100and the insertion part 52 of the treatment tool 50 are mutually held inparallel and held in parallel to the axis of the outer tube 100.

Here, the insertion part 52 of the treatment tool 50 is held to thesleeve 140, and the sleeve 140 is provided so as to be movable in theaxial direction with respect to the slider 118. Further, the frictionforce (F3) between the sleeve 140 and the treatment tool holding hole128 and the friction force (F1) between the guide shafts 120 and theguide holes 122 are set to be F3<F1.

As a result of this, when the insertion part 52 of the treatment tool 50is moved in the back-and-forth direction, the endoscope 10 does not movein the back-and-forth direction and only the treatment tool 50 moves inthe back-and-forth direction in the range of the allowance amount t ofthe sleeve 140 defined by the pair of stopper rings 142 and 142.

On the other hand, when the insertion part 52 of the treatment tool 50moves in the back-and-forth direction (axial direction) over the rangeof the allowance amount t, since F2>F1 is set, the slider 118 is pushedby the sleeve 140 and moves in the back-and-forth direction in anintegral manner with the treatment tool 50. As a result of this, theinsertion part 12 of the endoscope 10 moves in the back-and-forthdirection in interlock with the insertion part 52 of the treatment tool50.

Specifically, when the insertion part 52 moves in the advancingdirection (distal end direction) over the range of the allowance amountt of the sleeve 140, the distal end of the sleeve 140 abuts on thestopper ring 142 provided in the end part on the distal end side of thetreatment tool holding hole 128, and the slider 118 moves in theadvancing direction in an integral manner with the insertion part 52. Asa result of this, the insertion part 12 of the endoscope 10 moves in theadvancing direction together with the insertion part 52.

On the other hand, when the insertion part 52 moves in the retractingdirection (proximal end direction) over the range of the allowanceamount t of the sleeve 140, the proximal end of the sleeve 140 abuts onthe stopper ring 142 provided in the end part on the proximal end sideof the treatment tool holding hole 128, and the slider 118 moves in theretracting direction in an integral manner with the insertion part 52.As a result of this, the insertion part 12 moves in the retractingdirection together with the insertion part 52.

Thus, according to the endoscopic surgery device 1, the endoscope 10moves back and forth in the same direction in interlock with thetreatment tool 50 only when the treatment tool 50 is moved back andforth over the range of the allowance amount t. Moreover, as for aback-and-forth movement with a small amplitude of the treatment tool 50like slight shake in the range of the allowance amount t, since themovement is not transmitted to the endoscope 10, it is possible toprovide an excellent endoscopic image without shake.

Here, Ls1 varies according to the allowance amount t as illustrated inportion (A) and portion (B) of FIG. 9 . That is, Ls1 illustrated inportion (A) of FIG. 9 designates the maximum length of Ls1, and Ls1illustrated in portion (B) of FIG. 9 designates the minimum length ofLs1.

<<Use Example of Endoscopic Surgery Device 1>>

FIG. 10 is a schematic diagram illustrating one example of a surgeryprocedure using the endoscopic surgery device 1.

This example shows an example in a case where one surgeon performstreatment.

The endoscope 10 and the treatment tool 50 are inserted in a body cavity3 through the outer tube 100 tapped into the patient's body cavity wall2. The endoscope 10 moves back and forth in interlock with theback-and-forth movement of the treatment tool 50. By this means, animage of the treatment part is always displayed on the display 26.Moreover, it is possible to move a visual field by the movement of thetreatment tool 50.

Since illumination means is not included in the endoscope 10, the needlelight 30 is inserted in the body cavity 3 through the trocar 40 asillumination means. The body cavity 3 is illuminated by illuminationlight from the distal end of the needle light 30. Here, one needle light30 is exemplified in this example, but multiple pieces of needle light30 may be optionally used. As mentioned above, since the endoscope 10 isoperated by the operation of the treatment tool 50, a scopist isunnecessary.

<<Feature of Endoscopic Surgery Device 1 of First Embodiment>>

It lies in coupling the insertion part 12 of the endoscope 10 and theinsertion part 52 of the treatment tool 50 by a coupling member whichincludes the slider 118 and the sleeve 140 and which is disposed in theouter tube body 102.

As a result of this, since the insertion part 12 of the endoscope 10moves in the back-and-forth direction in interlock with theback-and-forth direction movement of the insertion part 52 of thetreatment tool 50, it is possible to synchronously move the insertionpart 12 of the endoscope 10 and the insertion part 52 of the treatmenttool 50, which are inserted in the outer tube 100, in the back-and-forthdirection. By this means, an image of the treatment part of thetreatment part 54 is always displayed on the display 26.

Moreover, it lies in coupling the insertion part 52 of the treatmenttool 50 with the coupling member such that the insertion part 52 moveswith respect to the insertion part 12 of the endo scope 10 with theallowance amount tin the axial direction of the outer tube 100.

By this means, it is possible to prevent the size of an observationtarget from varying in a case where the insertion part 52 is slightlydisplaced in the back-and-forth direction (in a case where theback-and-forth operation of small amplitude is performed), appropriatelykeep a depth perception and provide a stable observation image.Moreover, in a case where the insertion part 52 largely moves in theback-and-forth direction (in a case where a back-and-forth movement oflarge amplitude is performed), since the range of the observation imageis continuously changed in interlock with the movement of the insertionpart 52, the size of the observation target changes according to theoperation of the treatment tool 50, an image desired by a surgeon can beeasily obtained, and the operability improves.

In the first embodiment, the back and forth movement amount “a” of theinsertion part 52 of the treatment tool 50 with respect to the outertube 100 is set to 70 mm. That is, the back-and-forth movement amount“a” from the starting position of the back-and-forth movement of theinsertion part 52 illustrated in FIG. 11 to the terminal position of theback-and-forth movement of the insertion part 52 illustrated in FIG. 13is set to 60 mm or more. Moreover, in the first embodiment, theallowance amount tin the axial direction of the insertion part 52 of thetreatment tool 50 with respect to the insertion part 12 of the endoscope10 is set to 10 mm to 30 mm.

According to the first embodiment, in the back-and-forth movement amount“a” of the insertion part 52 of the treatment tool 50 with respect tothe outer tube 100, since the movement amount of 60 mm or more, togetherwith the allowance amount of 10 mm to 30 mm, is in a substantial userange which is normally used by the surgeon, the surgeon can operate thetreatment tool without a sense of incompatibility.

Here, it is preferable that the back-and-forth movement amount “a” is 80mm or less, and it is more preferable that it is 70 mm.

Moreover, it is preferable that the allowance amount t is 15 mm to 25mm, and it is more preferable that it is 20 mm.

In addition, it is preferable to set the minimum projection length Ls1to 50 mm and the allowance amount t to 20 mm. Since a range of 50 mm to70 mm, which is obtained by adding the allowance amount t=20 mm to theminimum projection length Ls1=50 mm, is in a substantial use range whichis normally used by the surgeon, the surgeon can operate the treatmenttool without a sense of incompatibility.

[One Example of Length of Endoscopic Surgery Device 1]

Length of outer tube 100: Lt=160 mm

Length of insertion part 12 of endoscope 10: Ls=250 mm

Length of insertion part 52 of treatment tool 50: Lh=360 mm

Viewing angle of endoscope 10: 120 degrees

Back-and-forth movement amount: a=70 mm

Allowance amount: t=20 mm

Minimum projection length: Ls1=50 mm

According to this endoscopic surgery device 1, in a case where theinsertion part 52 of the treatment tool 50 is moved in theback-and-forth direction within a normal use range, the treatment part54 can be imaged in a visual field range of observation means of theendoscope 10 without individually moving the insertion part 12 of theendoscope 10 with respect to the insertion part 52 in the axialdirection. Therefore, an image of the treatment site of the treatmentpart 54 is always displayed on the display 26 without following thetreatment part 54.

[Insertion Method of Endoscope 10 and Treatment Tool 50 into Outer Tube100]

FIG. 12 is a partial cross-sectional view in which the insertion part 12of the endoscope 10 is inserted in the outer tube 100, and FIG. 13 is apartial cross-sectional view in which the insertion part 52 of thetreatment tool 50 is inserted in the outer tube 100.

First, as illustrated in FIG. 12 , the insertion part 12 of theendoscope 10 is inserted from the endoscope entry port 112 (see FIG. 8). The insertion part 12 inserted in the endoscope entry port 112 isdelivered from the endoscope exit port 116 through the outer tube body102. In this case, the insertion part 12 is delivered from the endoscopeexit port 116 through the endoscope holding hole 132 formed in theslider 118 in an outer tube body. The O-rings 134 are provided in theendoscope holding hole 132, and the insertion part 12 passing throughthe endoscope holding hole 132 is held to the slider 118 by the elasticforce of the O-rings 134.

Next, the insertion part 52 of the treatment tool 50 is inserted fromthe treatment tool entry port 108 as illustrated in FIG. 13 . Theinsertion part 52 inserted in the treatment tool entry port 108 isdelivered from the treatment tool exit port 114 through the outer tubebody 102. In this case, the insertion part 52 is held to the sleeve 140by the elastic force of the O-rings 130. At this time, it only has toset the minimum projection length Ls1 to 50 mm. Afterward, the treatmenttool 50 is moved in the removal direction, and the endoscope 10 and thetreatment tool 50 are located in the use positions in FIG. 7 .

[Removal Method of Endoscope and Treatment Tool from Outer Tube 100]

First, the insertion part 52 of the treatment tool 50 is moved in theremoval direction from the state in FIG. 7 . Then, the sleeve 140 firstabuts on the stopper ring 142 on the proximal end surface first, and,after this, the slider 118 moves to the proximal end side of the outertube 100 together with the insertion part 52. Further, when the slider118 abuts on the proximal end of the outer tube 100 and the movement ofthe slider 118 is restricted, the insertion part 52 is removed from theslider 118, and the insertion part 52 is removed from the outer tube 100finally.

Next, when the insertion part 12 of the endoscope 10 is moved in theremoval direction, the insertion part 12 is removed from the slider 118,and the insertion part 12 is removed from the outer tube 100 finally.

Second Embodiment

FIG. 14 is a schematic diagram illustrating an internal structure of anouter tube 200 applied to an endoscopic surgery device according to thesecond embodiment. Moreover, FIG. 15 is a configuration diagramillustrating structures of a slider 208 and a sleeve 232 which arecomponents of the outer tube 200.

As illustrated in FIG. 14 , the outer tube 200 includes an outer tubebody 202, an endoscope insertion path 204, a treatment tool insertionpath 206, a slider 208, a position sensor 210, an endoscope drive unit212 and a control unit 214.

The outer tube body 202 is a guide member to be penetrated into a bodycavity through the patient's body wall. The endoscope insertion path 204and the treatment tool insertion path 206 are provided inside the outertube body 202.

The endoscope insertion path 204 is formed penetrating through the outertube body 202 along the axial direction of the outer tube body 202 andis configured as an insertion path in which the insertion part 12 can beinserted so as to be freely movable back and forth. The endoscopeinsertion path 204 communicates with an endoscope entry port 218 thatopens to a proximal end surface 216 of the outer tube body 202 andcommunicates with an endoscope exit port 222 that opens to a distal endsurface 220 of the outer tube body 202. By this means, the distal endpart of the insertion part 12 inserted in the endoscope entry port 218is delivered from the endoscope exit port 222 through the endoscopeinsertion path 204.

The treatment tool insertion path 206 is formed penetrating through theouter tube body 202 along the axial direction of the outer tube body 202and is configured so that the insertion part 52 can be inserted into thetreatment tool insertion path 206 so as to be freely movable back andforth. The treatment tool insertion path 206 communicates with atreatment tool entry port 224 that opens to the proximal end surface 216of the outer tube body 202 and communicates with a treatment tool exitport 226 that opens to the distal end surface 220 of the outer tube body202. By this means, a treatment part that is the distal end part of theinsertion part 52 inserted in the treatment tool entry port 224 isdelivered from the treatment tool exit port 226 through the treatmenttool insertion path 206.

Here, a check valve and a seal member are arranged in each of theendoscope insertion path 204 and the treatment tool insertion path 206to secure the air tightness in a body cavity, though illustration isomitted. By this means, it is possible to prevent carbon dioxide gasintroduced in the body cavity from flowing out from the body cavitythrough the endoscope insertion path 204 and the treatment toolinsertion path 206. Moreover, a stopper portion to prevent the slider208 described later from falling out is provided in end parts on thedistal end side and proximal end side of the treatment tool insertionpath 206, though illustration is omitted.

The slider 208 is an interlock member that is movable in the treatmenttool insertion path 206 in interlock with the back-and-forth movement ofthe insertion part 52, with an allowance with respect to the movement ofthe insertion part 52. The slider 208 is formed in a cylindrical shape,and a guide hole 230 forming an allowance part 209 is provided in theslider 208. This guide hole 230 is formed along the axial direction, anda sleeve 232 is housed in the guide hole 230. As illustrated in FIG. 15, an external diameter D3 of the sleeve 232 is formed to be smaller thanan internal diameter D5 of the guide hole 230. By this means, the sleeve232 is configured to be movable along an axial direction of the guidehole 230.

A treatment tool holding hole 234 which is formed penetrating throughthe sleeve 232 along the axial direction is provided inside the sleeve232. An inner wall part of the treatment tool holding hole 234 is formedwith a cylindrical elastic member 236. An internal diameter D1 of thetreatment tool holding hole 234 is formed to be slightly smaller than anexternal diameter (the external diameter of a part held by the treatmenttool holding hole 234) D2 of the insertion part 52 (see FIG. 14 ).Therefore, by inserting the insertion part 52 in the treatment toolholding hole 234, the sleeve 232 is held in a state where the sleeve 232is brought into close contact with an outer peripheral surface of theinsertion part 52 by the elastic force of the elastic member 236. Bythis means, the sleeve 232 can move in an integral manner with theinsertion part 52. Moreover, since the hold here denotes hold by theelastic force of the elastic member 236, a holding position of theinsertion part 52 can be arbitrarily adjusted with respect to the sleeve232.

Stopper portions 238A and 238B that prevent the sleeve 232 from droppingout from the guide hole 230 and restrict the movable range of the sleeve232 are provided in both end parts in the axial direction of the slider208. Openings 240A and 240B in which the insertion part 52 can beinserted are provided in the stopper portions 238A and 238Brespectively. That is, an internal diameter D4 of each of the openings240A and 240B is formed to be larger than the external diameter D2 ofthe insertion part 52 and smaller than the external diameter D3 of thesleeve 232. Therefore, when the insertion part 52 moves back and forthin a state where the sleeve 232 is held to the outer circumference partof the insertion part 52, the slider 208 does not move back and forth ifthe back-and-forth movement of the insertion part 52 is within anallowance range (a movable range defined by the stopper portions 238Aand 238B) of the slider 208. On the other hand, in a case where theinsertion part 52 moves back and forth over the allowance range of theslider 208, the sleeve 232 held to the insertion part 52 abuts on thestopper portion 238A or 238B, and the slider 208 moves back and forth inan integral manner with the insertion part 52.

The position sensor 210 illustrated in FIG. 14 detects the movementamount of the slider 208 that can move in interlock with theback-and-forth movement of the insertion part 52, with an allowance withrespect to the movement of the insertion part 52. That is, the positionsensor 210 is configured as detection means that has: a non-sensitivearea in which a change of the relative position of the insertion part 52with respect to the insertion part 12 is not detected even if theinsertion part 52 moves back and forth, and a sensitive area in which achange of the relative position of the insertion part 52 is detectedwhen the insertion part 12 moves back and forth, and that detects themovement amount of the insertion part 52 with respect to the outer tubebody 202 in the sensitive area. As the position sensor 210, it ispossible to use position sensors such as a potentiometer, an encoder andan MR (Magnetic Resistance) sensor. For example, by detecting therotation amount of a rotation body (roller) configured to be rotatableaccording to the back-and-forth movement of the slider 208 using arotary encoder and a potentiometer, and so on, it is possible to detectthe movement amount of the slider 208. The detection result of theposition sensor 210 is output to the control unit 214.

Here, it is assumed that the movement amount of the slider 208, which isdetected by the position sensor 210, has a positive/negative valueaccording to the movement direction. Specifically, the movement amountof the slider 208 in a case where the slider 208 moves to the diseasedpart side (distal end side or forward side) in a body cavity is assumedto have a positive value, and the movement amount of the slider 208 in acase where it moves to the hand side (proximal end side or backwardside), which is the opposite side to the diseased part side, is assumedto have a negative value.

The endoscope drive unit 212 is drive means to move the insertion part12 inserted in the endo scope insertion path 204 back and forth, and,for example, composed of a motor, a gear and so on. The endoscope driveunit 212 moves the insertion part 12 back and forth on the basis of acontrol signal output from the control unit 214. In this example, theendoscope drive unit 212 is built into the outer tube body 202, but itis not limited to this, and the endoscope drive unit may be one whichmoves the insertion part 12 back and forth from outside of the outertube body 202.

The control unit 214 is endoscope movement control means to control theback-and-forth movement of the insertion part 12 through the endoscopedrive unit 212 on the basis of the detection result of the positionsensor 210. That is, the control unit 214 controls the back-and-forthmovement of the insertion part 12 according to the movement amount ofthe slider 208, and moves the insertion part 12 in interlock with theback-and-forth movement of the insertion part 52, with an allowance withrespect to the movement of the insertion part 52.

The control unit 214 may be built into the outer tube body 202 or may beconnected with the outside of the outer tube body 202 through wiring.

FIG. 16 is a flowchart diagram illustrating one example of processingperformed in the control unit 214.

First, the control unit 214 acquires the movement amount of the slider208 detected by the position sensor 210 (step S10).

Next, the control unit 214 performs control to move the insertion part12 back and forth through the endoscope drive unit 212 on the basis ofthe movement amount of the slider 208 which is acquired from theposition sensor 210 (step S12). Specifically, the control unit 214outputs to the endoscope drive unit 212 a control signal for moving theinsertion part 12 back and forth by the same movement amount as themovement amount of the slider 208. Then, the endoscope drive unit 212moves the insertion part 12 back and forth on the basis of the controlsignal given from the control unit 214. By this means, the insertionpart 12 moves back and forth by the same movement amount as the movementamount of the slider 208, that is, moves back and forth with anallowance with respect to the movement amount of the insertion part 52,in interlock with (synchronously with) the insertion part 52.

FIG. 17 is an explanatory diagram illustrating a state when anendoscopic surgery device according to the second embodiment isoperated. FIG. 17 is a diagram illustrating a state when the insertionpart 52 is pushed from the hand side into the diseased part side in abody cavity.

First, in a case where the insertion part 52 is slightly displaced inthe axial direction (in a case where a back-and-forth operation of smallamplitude is performed) like displacement from the state illustrated inportion (A) of FIG. 17 to the state illustrated in portion (B) of FIG.17 , only the insertion part 52 moves back and forth and the slider 208does not move back and forth. Thus, the output of the position sensor210 that detects the movement amount of the slider 208 becomes 0. Inthis case, since the insertion part 12 does not move back and forth, therange of an observation image displayed on the display 26 (see FIG. 2 )does not change. Therefore, it is possible to prevent the size of theobservation target from varying according to the slight displacement ofthe insertion part 52, appropriately keep a depth perception and obtaina stable observation image.

By contrast with this, in a case where the insertion part 52 is largelydisplaced in the axial direction (in a case where a back-and-forthoperation of large amplitude is performed) like displacement from thestate illustrated in portion (A) of FIG. 17 to the state illustrated inportion (C) of FIG. 17 , the slider 208 moves back and forth ininterlock with the back-and-forth movement of the insertion part 52. Inthis case, since the insertion part 12 moves back and forth, the rangeof the observation image displayed on the display 26 is continuouslychanged so as to follow the back-and-forth movement of the insertionpart 52. By this means, since the size of the observation target changesaccording to the operation of the treatment tool 50, it becomes possibleto easily obtain an image desired by a surgeon.

Moreover, it is also similar to a case where the insertion part 52 isdrawn from the diseased part side in the body cavity to the hand sidethough illustration is omitted.

Here, it is preferable to perform control so as to move the insertionpart 12 back and forth such that the range of the observation imagedisplayed on the display 26 is always constant even if the insertionpart 52 is moved back and forth.

As mentioned above, in the second embodiment, the insertion part 12moves back and forth with an allowance with respect to theback-and-forth movement of the insertion part 52 by the position sensor210.

By this means, it is possible to prevent the size of the observationtarget from varying in a case where the insertion part 52 is slightlydisplaced in the back-and-forth direction (in a case where aback-and-forth operation of small amplitude is performed), appropriatelykeep a depth perception and provide a stable observation image.Moreover, in a case where the insertion part 52 is largely displaced inthe back-and-forth direction (in a case where a back-and-forth operationof large amplitude is performed), since the range of the observationimage is continuously changed in interlock with the displacement of theinsertion part 52, the size of the observation target changes accordingto the operation of the treatment tool 50, an image desired by a surgeoncan be easily obtained and the operability is improved.

Third Embodiment

Next, the third embodiment is described. In the following, explanationis omitted for common parts with the second embodiment andcharacteristic parts of the third embodiment are mainly described.

FIG. 18 is a schematic configuration diagram illustrating a mainconfiguration of an endoscope device according to the third embodiment.In FIG. 18 , the same reference numerals are assigned to componentswhich are the same as or correspond to the components illustrated in theabove-mentioned drawings.

In the third embodiment, as illustrated in FIG. 18 , a scale area 260 inwhich a movement amount of the insertion part 52 with respect to theouter tube body 202 can be detected by a detection sensor 242 describedlater and a non-scale area 262 in which the above-mentioned movementamount is not detected are set in the outer peripheral surface of theinsertion part 52.

The scale area 260 includes high density parts and low density partswhich are alternately repeated along the axial direction of theinsertion part 52.

The non-scale area 262 includes uniform density parts each having auniform density along the axial direction of the insertion part 52, andthe uniform density parts are formed on both sides of the scale area 260(that is, on the distal end side and proximal end side of the insertionpart 52 in the axial direction).

Inside the outer tube body 202, the detection sensor 242 is provided asdetection means to detect a change in the relative position of theinsertion part 52 with respect to the insertion part 12 when theinsertion part 52 moves back and forth. This detection sensor 242 isoptical reading means which optically reads the high density parts andlow density parts of the scale area 260 formed in the insertion part 52,and, for example, is configured by a light emitting element and a lightreceiving element. For example, if the scale area 260 passes through aposition facing the detection sensor 242 when the insertion part 52moves back and forth, the movement amount of the insertion part 52 isdetected by the detection sensor 242. On the other hand, in a case wherethe non-scale area 262 passes through the position facing the detectionsensor 242, the movement amount of the insertion part 52 is not detectedby the detection sensor 242. The detection result of the detectionsensor 242 is output to the control unit 214.

Here, the detection sensor 242 is not limited to the optical readingmeans, and, for example, the detection sensor 242 may be configured byreading means which can perform magnetically reading or electricallyreading. In this case, scale information corresponding to the readingmeans is formed in the outer peripheral surface of the insertion part52.

The control unit 214 controls the endoscope drive unit 212 on the basisof the detection result of the detection sensor 242. That is, thecontrol unit 214 performs control to move the insertion part 12 throughthe endoscope drive unit 212 according to the movement amount of theinsertion part 52, which is detected by the detection sensor 242.

According to the third embodiment, the detection sensor 242 can detectthe movement amount of the insertion part 52, with an allowance withrespect to the back-and-forth movement of the insertion part 52. By thismeans, it becomes possible to move the insertion part 12 back and forthwith the allowance in interlock with (synchronously with) theback-and-forth movement of the insertion part 52.

By this means, it is possible to prevent the size of an observationtarget from varying in a case where the insertion part 52 is slightlydisplaced in the back-and-forth direction (in a case where aback-and-forth operation of small amplitude is performed), appropriatelykeep a depth perception and provide a stable observation image.Moreover, in a case where the insertion part 52 is largely displaced inthe back-and-forth direction (in a case where a back-and-forth operationof large amplitude is performed), since the range of the observationimage is continuously changed in interlock with the displacement of theinsertion part 52, the size of the observation target changes accordingto the operation of the treatment tool 50, an image desired by a surgeoncan be easily obtained, and the operability improves.

Fourth Embodiment

Next, the fourth embodiment is described. In the following, explanationis omitted for common parts with the second and third embodiments, andcharacteristic parts of the present embodiment are mainly described.

FIG. 19 is a functional block diagram illustrating a main configurationof an endoscopic surgery device according to the fourth embodiment. InFIG. 19 , the same reference numerals are assigned to components whichare the same as or correspond to the components illustrated in theabove-mentioned drawings.

In the fourth embodiment, there is provided a treatment tool movementamount detection unit 244 as detection means which detects the movementamount of the insertion part 52, with an allowance with respect to theback-and-forth movement of the insertion part 52 on the basis of imagedata generated by an image data generation unit 266 of the imageprocessing device 24. Similar to the control unit 214, the treatmenttool movement amount detection unit 244 may be built into the outer tubebody 202 or may be connected with the outside of the outer tube body 202through wiring.

The treatment tool movement amount detection unit 244 includes amovement amount calculation unit 246, a first conversion processing unit248 and a second conversion processing unit 250.

The movement amount calculation unit 246 calculates the movement amountof the insertion part 52 on the basis of the image data generated by theimage data generation unit 266. The movement amount calculated at thistime is a movement amount X₁ on an observation image as illustrated inportion (A) of FIG. 20 and is different from an actual movement amountX₂ illustrated in portion (B) of FIG. 20 . Here, a reference character Pdesignates the movement starting position of the insertion part 52.

The first conversion processing unit 248 converts the movement amount X₁on the observation image, which is calculated by the movement amountcalculation unit 246, into the actual movement amount X₂. Specifically,the first conversion processing unit 248 converts the movement amount X₁on the observation image into the actual movement amount X₂ withreference to a lookup table. Here, a correspondence relationship betweenthe movement amount X₁ on the observation image and the actual movementamount X₂ is uniquely decided from the clearance (distance) between theinsertion part 52 and the insertion part 12, and the angle of view ofthe imaging element 20 of the endoscope 10, and so on. Data showing thecorrespondence relationship between these are stored in an unillustratedmemory as the lookup table.

The second conversion processing unit 250 converts the movement amount(actual movement amount) X₂ of the insertion part 52, which is obtainedby the first conversion processing unit 248, into a movement amount X₃to which a fixed allowance amount is given. Specifically, the secondconversion processing unit 250 performs conversion processing to themovement amount of the insertion part 52 according to the graphillustrated in FIG. 21 . That is, the movement amount X₃ of theinsertion part 52 is set to 0 (zero) in a case where the movement amountX₂ of the insertion part 52 is within an allowance range. On the otherhand, the movement amount X₃ is set to a value obtained by subtracting afixed value from the movement amount X₂ of the insertion part 52 or avalue obtained by adding the fixed value to the movement amount X₂ ofthe insertion part 52 in a case where movement amount X₂ of theinsertion part 52 is not within the above-mentioned allowance range. Themovement amount X₃ of the insertion part 52, which is obtained in thisway, is output to the control unit 214 as a detection result of thetreatment tool movement amount detection unit 244.

The control unit 214 controls the back-and-forth movement of theinsertion part 12 through the endo scope drive unit 212 on the basis ofthe detection result of the treatment tool movement amount detectionunit 244.

According to the fourth embodiment, the movement amount when theinsertion part 52 is moved back and forth on the basis of image data, isdetected with an allowance. Therefore, it becomes possible to move theinsertion part 12 back and forth with the allowance with respect to theback-and-forth movement of the insertion part 52.

By this means, it is possible to prevent the size of an observationtarget from varying in a case where the insertion part 52 is slightlydisplaced in the back-and-forth direction (in a case where aback-and-forth operation of small amplitude is performed), appropriatelykeep a depth perception and provide a stable observation image.Moreover, in a case where the insertion part 52 is largely displaced inthe back-and-forth direction (in a case where a back-and-forth operationof large amplitude is performed), since the range of the observationimage is continuously changed in interlock with the displacement of theinsertion part 52, the size of the observation target changes accordingto the operation of the treatment tool 50, an image desired by a surgeoncan be easily obtained, and the operability improves.

Fifth Embodiment

Next, the fifth embodiment is described. In the following, explanationis omitted for common parts with the second embodiment andcharacteristic parts of the third embodiment are mainly described.

FIG. 22 is a schematic diagram illustrating an internal structure of theouter tube 200.

The control unit 214 of the fifth embodiment is endoscope movementcontrol means which controls the back-and-forth movement of theinsertion part 12 through the endoscope drive unit 212 on the basis of adetection result of the position sensor 210. Specifically, the controlunit 214 performs control according to the graph illustrated in FIG. 23.

The position sensor 210 detects the movement amount of the insertionpart 52 inserted in the treatment tool insertion path 206. That is, theposition sensor 210 is formed as detection means which detects themovement amount of the insertion part 52 with respect to the outer tubebody 202 when the insertion part 52 moves back and forth.

FIG. 23 is a graph illustrating the relationship between a movementamount X of the insertion part 52 and a movement amount Y of theinsertion part 12. As illustrated in FIG. 23 , in a case where themovement amount X of the insertion part 52 is within a predeterminedallowance range in which the movement amount X of 0 (zero) is set as acenter, the control unit 214 performs control to set the movement amountY of the insertion part 12 to 0 (zero). That is, in a case where themovement amount X of the insertion part 52 satisfies −t≤X≤t (here, t>0is assumed), the insertion part 12 is not moved back and forth.

On the other hand, in a case where the movement amount X of theinsertion part 52 is not within the above-mentioned allowance range, thecontrol unit 214 performs control to move the insertion part 12 back andforth in interlock with the back-and-forth movement of the insertionpart 52. Specifically, the control unit 214 performs control to set avalue obtained by adding the allowance amount t to the movement amount Xof the insertion part 52 or a value obtained by subtracting theallowance amount t from the movement amount X of the insertion part 52,as the movement amount Y of the insertion part 12.

By this means, it becomes possible to move the insertion part 12 backand forth with an allowance with respect to the movement of theinsertion part 52, in interlock with (synchronously with) theback-and-forth movement of the insertion part 52.

FIG. 24 is a flowchart diagram illustrating one example of processingperformed in the control unit 214.

First, the control unit 214 acquires the movement amount of theinsertion part 52 which is detected by the position sensor 210 (stepS100).

Next, the control unit 214 determines whether or not the movement amountof the insertion part 52 which is acquired from the position sensor 210,is within an allowance range set beforehand (step S120). In a case wherethe movement amount of the insertion part 52 is within the allowancerange, the control unit 214 skips step S140 and proceeds to step S160.

On the other hand, in a case where the movement amount of the insertionpart 52 is not within the allowance range, as mentioned above, thecontrol unit 214 performs control to move the insertion part 12 back andforth in interlock with the back-and-forth movement of the insertionpart 52 according to the graph illustrated in FIG. 23 (step S140).

Next, the control unit 214 determines whether or not the operation hasended (step S160). In a case where it is determined that the operationdoes not end, the process returns to step S100 and similar processing isperformed. On the other hand, in a case where it is determined that theoperation has ended, control by the control unit 214 ends.

As a determination method as to whether or not the operation has ended,for example, it may be possible to install a sensor that detects whetheror not the insertion part 12 or the insertion part 52 is inserted in theouter tube body 202, and determine the end of the operation according toa detection result of this sensor. Moreover, it may be possible toinstall an ON/OFF switch that can be manually operated, and determinethe end of the operation according to the operational state of thisON/OFF switch.

By the above-mentioned configuration, since an allowance is given to thecontrol unit 214, the insertion part 12 moves back and forth with theallowance with respect to the back-and-forth movement of the insertionpart 52.

By this means, it is possible to prevent the size of an observationtarget from varying in a case where the insertion part 52 is slightlydisplaced in the back-and-forth direction (in a case where aback-and-forth operation of small amplitude is performed), appropriatelykeep a depth perception and provide a stable observation image.Moreover, in a case where the insertion part 52 is largely displaced inthe back-and-forth direction (in a case where a back-and-forth operationof large amplitude is performed), since the range of the observationimage is continuously changed in interlock with the displacement of theinsertion part 52, the size of the observation target changes accordingto the operation of the treatment tool 50, an image desired by a surgeoncan be easily obtained, and the operability improves.

Sixth Embodiment

Next, the sixth embodiment is described. In the following, explanationis omitted for common parts with the second embodiment andcharacteristic parts of the sixth embodiment are mainly described.

FIG. 25 is a schematic diagram illustrating an internal structure of theouter tube 200. Moreover, FIG. 26 is a diagram illustrating structuresof the slider 208 and the sleeve 232.

In the sixth embodiment, the endoscope drive unit 212 moves theinsertion part 12 which is inserted in the endoscope insertion path 204back and forth with an allowance. That is, the endoscope drive unit 212is formed as endoscope drive means having: a non-operation area in whichthe insertion part 12 is not moved back and forth; and an operation areawhich is an area other than the non-operation area, and in the operationarea the insertion part 12 is moved back and forth. For example, theendoscope drive unit 212 includes a motor, a gear, and so on, besidesthe slider 208 described later. The endoscope drive unit 212 moves theinsertion part 12 back and forth on the basis of a control signal outputfrom the control unit 214. In this example, the endoscope drive unit 212is built into the outer tube body 202, but it is not limited to this,and it may move the insertion part 12 back and forth outside the outertube body 202.

The slider 208 is a drive member that can move back and forth in theendoscope insertion path 204. By moving back and forth in the endoscopeinsertion path 204, this slider 208 synchronously moves the insertionpart 12 back and forth with an allowance. The slider 208 is formed in acylindrical shape, and the guide hole 230 forming an allowance part 209is provided inside the slider 208. This guide hole 230 is formed alongthe axial direction, and the sleeve 232 is housed in the guide hole 230.As illustrated in FIG. 26 , an external diameter D3 of the sleeve 232 isformed to be smaller than an internal diameter D5 of the guide hole 230.By this means, the sleeve 232 is formed to be movable along the axialdirection of the guide hole 230.

An endoscope holding hole 234 formed penetrating along the axialdirection is provided inside the sleeve 232. An inner wall part of theendoscope holding hole 234 is configured by a cylindrical elastic member236. An internal diameter D1 of the endoscope holding hole 234 is formedto be slightly smaller than an external diameter (an external diameterof a part held by the endoscope holding hole 234) D2 of the insertionpart 12 (see FIG. 25 ). Therefore, by inserting the insertion part 12 inthe endoscope holding hole 234, the sleeve 232 is held in a state wherethe sleeve 232 is brought into close contact with the outer peripheralsurface of the insertion part 12 by the elastic force of the elasticmember 236. By this means, the sleeve 232 becomes possible to move in anintegral manner with the insertion part 12.

The stopper portions 238A and 238B that prevent the sleeve 232 fromdropping out from the guide hole 230 and restrict the movable range ofthe sleeve 232 are provided in both end parts in the axial direction ofthe slider 208. The openings 240A and 240B that can insert the insertionpart 12 are provided in the stopper portions 238A and 238B respectively.That is, internal diameter D4 of each of the openings 240A and 240B isformed to be larger than the external diameter D2 of the insertion part12 and smaller than the external diameter D3 of the sleeve 232.Therefore, when the slider 208 moves back and forth in a state where thesleeve 232 is held to the outer circumference part of the insertion part12, the insertion part 12 does not move back and forth if theback-and-forth movement of the insertion part 52 is within an allowancerange of the slider 208 (a movable range defined by the stopper portions238A and 238B). On the other hand, in a case where the insertion part 52moves back and forth over the allowance range of the slider 208, thesleeve 232 held to the insertion part 12 abuts on the stopper portion238A or 238B and the insertion part 12 moves back and forth in anintegral manner with the insertion part 12.

The control unit 214 illustrated in FIG. 25 is control means whichcontrols the endoscope drive unit 212 on the basis of a detection resultof the position sensor 210. That is, the control unit 214 controls theback-and-forth movement of the slider 208 in the endoscope drive unit212 in proportion to the movement amount of the insertion part 52. Bythis control by the control unit 214, the insertion part 12 moves backand forth in proportion to the movement amount of the insertion part 52in the operation area.

FIG. 27 is an explanatory diagram illustrating a state when an endoscopedevice according to the sixth embodiment is operated. FIG. 27 is adiagram illustrating a state when the insertion part 52 is pushed fromthe hand side to the diseased part side in a body cavity.

First, in a case where the insertion part 52 is slightly displaced inthe axial direction (in a case where a back-and-forth operation of smallamplitude is performed) like a movement from the state illustrated inportion (A) of FIG. 27 to the state illustrated in portion (B) of FIG.27 , since only the slider 208 moves back and forth, and the insertionpart 12 does not move back and forth, the range of an observation imagedisplayed on the display 26 does not change. Therefore, it is possibleto prevent the size of the observation target from varying according tothe slight displacement of the insertion part 52, appropriately keep adepth perception and obtain a stable observation image.

By contrast with this, in a case where the insertion part 52 is largelydisplaced in the axial direction (in a case where a back-and-forthoperation of large amplitude is performed) like a movement from thestate illustrated in portion (A) of FIG. 27 to the state illustrated inportion (C) of FIG. 27 , the insertion part 12 moves back and forth ininterlock with the back-and-forth movement of the slider 208. By thismeans, the range of the observation image displayed on the display 26 iscontinuously changed so as to follow the back-and-forth movement of theinsertion part 52. Thus, since the size of the observation targetchanges according to the operation of the treatment tool 50, it becomespossible to easily obtain an image desired by a surgeon.

Moreover, it is also similar to a case where the insertion part 52 isdrawn from the diseased part side in the body cavity to the hand sidethough illustration is omitted.

Here, it is preferable to perform control so as to move the insertionpart 12 back and forth such that the range of the observation imagedisplayed on the display 26 is always constant even if the insertionpart 52 is moved back and forth.

According to the configuration above, by moving the slider 208 back andforth in the endoscope insertion path 204, the insertion part 12 movesback and forth with an allowance with respect to the back-and-forthmovement of the insertion part 52.

By this means, it is possible to prevent the size of an observationtarget from varying in a case where the insertion part 52 is slightlydisplaced in the back-and-forth direction (in a case where aback-and-forth operation of small amplitude is performed), appropriatelykeep a depth perception and provide a stable observation image.Moreover, in a case where the insertion part 52 is largely displaced inthe back-and-forth direction (in a case where back-and-forth operationof large amplitude is performed), since the range of the observationimage is continuously changed in interlock with the displacement of theinsertion part 52, the size of the observation target changes accordingto the operation of the treatment tool 50, an image desired by a surgeoncan be easily obtained, and the operability improves.

What is claimed is:
 1. An endoscopic surgery device comprising: an outertube; a slider provided in the outer tube; and a sleeve provided in theouter tube; wherein the slider has a first stopper and a second stopperwhich are provided to be physically separated from each other in alongitudinal direction of the outer tube, wherein the sleeve is locatedon a first path formed between the first stopper and the second stopper,and the sleeve is slidable on the first path along the longitudinaldirection of the outer tube, and wherein the sleeve is prevented fromextending beyond a position of the first stopper and a position of thesecond stopper in the longitudinal direction of the outer tube; whereinthe slider has a first holding part including a first holding hole thatholds an insertion part of a first rod-shaped member and a second paththrough which the first rod-shaped member is inserted, wherein thesleeve has a third path through which a second rod-shaped member isinserted and a second holding part including a second holding hole thatholds an insertion part of the second rod-shaped member inserted throughthe third path.
 2. The endoscopic surgery device according to claim 1,wherein a distance between the sleeve and either one of the firststopper and the second stopper is in a range of 10 mm to 30 mm.
 3. Theendoscopic surgery device according to claim 1, further comprising, afirst cap provided at a proximal end of the outer tube.
 4. Theendoscopic surgery device according to claim 3, wherein the first caphas an airtight valve.
 5. The endoscopic surgery device according toclaim 3, wherein the first cap has a first port through which the firstrod-shaped member is inserted and a second port through which the secondrod-shaped member is inserted.
 6. The endoscopic surgery deviceaccording to claim 1, further comprising at least one guide shaft whichis provided in the outer tube along the longitudinal direction of theouter tube, one of the at least one guide shaft is located on a fourthpath provided in the slider and is configured to guide the sliderslidably in the longitudinal direction of the outer tube.
 7. Theendoscopic surgery device according to claim 6, further comprising, asecond cap which is provided at a distal end of the outer tube and towhich one end of the at least one guide shaft is fixed.
 8. Theendoscopic surgery device according to claim 6, wherein the at least oneguide shaft is round rod-shaped.
 9. The endoscopic surgery deviceaccording to claim 6, wherein a number of guide shafts provided in theouter tube is two.
 10. The endoscopic surgery device according to claim4, wherein the first holding part has one or more O-rings.
 11. Theendoscopic surgery device according to claim 10, wherein the one or moreO-rings comprise at least two O-rings that are disposed along the secondpath.
 12. The endoscopic surgery device according to claim 1, whereinthe second holding part has at least one O-ring.
 13. The endoscopicsurgery device according to claim 12, wherein the at least one O-ringcomprises at least two O-rings that are disposed along the third path.14. The endoscopic surgery device according to claim 12, wherein innerdiameters of the first stopper and the second stopper are smaller thanan inner diameter of the at least one O-ring.
 15. The endoscopic surgerydevice according to claim 1, further comprising a second cap provided ata distal end of the outer tube.
 16. The endoscopic surgery deviceaccording to claim 15, wherein the second cap has a third port throughwhich the first rod-shaped member is inserted and a fourth port throughwhich the second rod-shaped member is inserted.
 17. An endoscopicsurgery device, comprising: an outer tube; a slider provided in theouter tube; a sleeve provided in the outer tube; a first cap provided ata proximal end of the outer tube; an airtight valve provided in thefirst cap; two round rod-shaped guide shafts which are provided in theouter tube along a longitudinal direction of the outer tube and areconfigured to guide the slider slidably in the longitudinal direction ofthe outer tube; and a second cap which is provided at a distal end ofthe outer tube and to which one end of each guide shaft is fixed,wherein the slider has a first stopper and a second stopper which areprovided separately from each other in the longitudinal direction of theouter tube, wherein the sleeve is slidably located on a first pathfonned between the first stopper and the second stopper, wherein theslider has a first holding part configured to hold a first rod-shapedmember and a second path through which the first rod-shaped member isinserted, wherein the sleeve has a third path through which a secondrod-shaped member is inserted and a second holding part configured tohold the second rod-shaped member inserted through the third path,wherein a distance between the sleeve and either one of the firststopper and the second stopper is in a range of 10 mm to 30 mm, whereinthe first cap has a first port through which the first rod-shaped memberis inserted and a second port through which the second rod-shaped memberis inserted, wherein the first holding part has at least two O-ringswhich are disposed along the second path, wherein the second holdingpart has at least two O-rings which are disposed along the third path,wherein inner diameters of the first stopper and the second stopper aresmaller than inner diameters of the at least two O-rings of the firstholding part and the at least two O-rings of the second holding part,wherein the second cap has a third port through which the firstrod-shaped member is inserted and a fourth port through which the secondrod-shaped member is inserted.